1750406732 NPI number — CARLOS E RODRIGUEZ MD PA

Table of content: (NPI 1750406732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750406732 NPI number — CARLOS E RODRIGUEZ MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARLOS E RODRIGUEZ MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750406732
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
708 S BIBB AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAGLE PASS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78852-5069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-773-7339
Provider Business Mailing Address Fax Number:
830-773-4618

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
708 S BIBB AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAGLE PASS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78852-5069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-773-7339
Provider Business Practice Location Address Fax Number:
830-773-4618
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
830-773-7339

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  F7109 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 87830G . This is a "BLUE CROSS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 079788801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com